Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: a case series.

OBJECTIVE: To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. MATERIALS AND METHODS: From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. RESULTS: The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. CONCLUSIONS: The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity.

Laparoscopic rectovesical fistula repair.

BACKGROUND AND PURPOSE: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 62- year-old man with clinically localized prostate cancer underwent open radical prostatectomy that was complicated by rectal injury and subsequent RVF development. Conservative management failed, and the patient was referred for surgical correction. TECHNIQUE: The operative steps consisted of (1) cystoscopy, (2) RVF catheterization, (3) ureteral catheterization, (4) five-port transperitoneal laparoscopic approach, (5) cystotomy, (6) opening of the fistulous tract, (7) dissection between the bladder and the rectum, (8) closure of the rectum, (9) interposition of omentum, (10) suprapubic cystostomy placement, (11) bladder closure, and (12) colostomy creation. RESULTS: The operative time was 240 minutes. The hospital stay was 3 days. The urethral catheter was kept indwelling for 4 days. At 8 weeks postoperatively, the suprapubic tube was removed and the colostomy reversed. At 1-month follow-up, the patient remains free of fistula recurrence. CONCLUSION: Laparoscopic rectovesical fistula repair is feasible and represents an attractive alternative to the standard approaches.

Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

Objective To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. Materials and Methods From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity. .

Laparo-endoscopia por acceso único: experiencia inicial / Laparo-endoscopic single site (LESS)

Objetivo: Presentar nuestra experiencia inicial en LESS Surgery (Laparo-Endoscopic Single Site Surgery/Cirugía laparoendoscópica por acceso único), mediante uso de dispositivo multicanal, instrumentos estándar, articulables y otros adaptados para la consecución de los procedimientos. Materiales y métodos: Entre febrero y septiembre del 2008 se realizaron 28 procedimientos quirúrgicos LESS con puerto multicanal: prostatectomía simple transumbilical (PSTU) y transvesical (PSTV), nefrectomía simple (NS), enterocistoplastia de aumento (ECA) e histerectomía simple (HS). Los datos clínicos fueron recopilados de manera prospectiva y analizados retrospectivamente. Se utilizó dispositivo de acceso multicanal (R-Port). Los procedimientos fueron realizados en un centro por un solo cirujano (RS). La técnica quirúrgica empleada correspondió a la misma utilizada por vía laparoscópica convencional. Resultados: Se realizaron 28 intervenciones quirúrgicas: PSTU (01), PSTV(20), NS(01), ECA(01), HS(05). La incisión de acceso fue realizada a nivel umbilical o infraumbilical. Solo un caso (nefrectomía) ameritó uso de trocar adicional de 2 mm. La edad media en años por procedimiento fue: PSTU, 67; PSTV, 68 (57–89); NS, 12; ECA, 20; HS, 46.4 (41–54). El tiempo quirúrgico medio en minutos fue: PSTU, 120; PSTV, 91 (45–210); NS, 120; ECA, 300; HS, 112 (90–160). El sangrado operatorio fue: PSTU, 200cc; PSTV, 337 cc (50-1500); NS, 100cc; EAC, 100cc; HS, 118cc. (100–160). La complicación observada fue hematuria profusa en dos casos de PSTV, ambos pacientes requirieron exploración postoperatoria con evolución satisfactoria. Conclusiones: LESS es una alternativa factible y reproducible en patología uroginecológica de resolución quirúrgica. Mayores estudios, experiencias y seguimiento permitirán la evaluación objetiva de esta técnica (AU)

Objetive: We present our initial experience in laparo-endoscopic single site (LESS) surgery, through multichannel port, articulated instruments and standard instruments adapted others adapted for the procedures. Materials and methods: Between February and October 2008, 28 LESS surgical procedures with multi-port were performed (Transumbilical simple prostatectomy (PSTU) and transvesical (PSTV), simple nephrectomy (NS), Enterocystoplasty augmentation (ECA) and simple hysterectomy (HS)). The clinical data were collected prospectively and analyzed retrospectively. Was used access device Multichannel (R-Port). The procedures were performed for a single surgeon (RS). The surgical technique was the same route used by conventional laparoscopic. Results: Twenty-eight surgeries were performed: PSTU (01), PSTV (20), NS (01), ECA (01), HS (05). The incision was performed umbilical or infraumbilical. Only one case (nephrectomy) needed it placement of an additional trocar. The average age by procedure was PSTU and PSTV, 67 and 68 year-old (57-89 y) respectively; NS 12 year-old; RCT 20 year-old; HS 46.4year-old (41 – 54 y). The operative time was: PSTU 120 minutes, PSTV 91 minutes (45-210 min); NS 120 minutes; RCT 300minutes; HS 112 minutes (90-160 min). The operative bleeding was PSTU and PSTV 200 cc. and 337 cc (50-1500 cc) respectively; NS 100cc; EAC 100 cc; HS 118 cc (100-160 cc). The complication was haematury in two cases of PSTV, both patients required exploration postoperative endoscopic with satisfactory evolution. Conclusions: LESS is a feasible and reproducible surgical option in uro-gynecologic surgical treatment. Further studies, experience and follow-up will provide an objective assessment of the technique (AU)